This study is a cross sectional self-administered mailed survey to address the type and frequency of ethical dilemmas faced by physicians, how they approach them, the types of ethical support they would find useful in addressing these ethical dilemmas, and their attitudes and practices in situations of scarce resources. The questionnaire has been designed, piloted, translated and back translated. The study sample will include 400 general practitioners and general internists from each of four European countries including England, Switzerland, Norway and Italy. the study has been amended to include 500 U.S. internists for comparison with the European sample. IRB approval has been attained at the NIH and in each of the participating countries for the original sample. IRB approval at the NIH for the additional U.S. sample has been obtained and OMB approval is being sought. Data collection is currently complete for the European sample and will begin for the U.S. sample at the beginning of 2005. Six manuscript are in preparation regarding the European sample and abstracts have been presented at the the International Society of Priorities in Health Care meeting and will be presented at the International Association of Bioethics meeting in November 2005.